RESUMO
INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. METHODS: A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. RESULTS: Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). CONCLUSIONS: Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.
Assuntos
Sintomas do Trato Urinário Inferior , Prolapso de Órgão Pélvico , Incontinência Urinária por Estresse , Humanos , Feminino , Gravidez , Estudos Prospectivos , Resultado do Tratamento , Prolapso de Órgão Pélvico/complicações , Incontinência Urinária por Estresse/cirurgia , Colpotomia/efeitos adversos , Sintomas do Trato Urinário Inferior/cirurgia , Sintomas do Trato Urinário Inferior/complicaçõesRESUMO
la incontinencia urinaria (IU), se define por la Sociedad Internacional de Continencia, como la perdida involuntaria de orina, una condición potencialmente tratable con disminución de la calidad de vida de las mujeres en diferentes aspectos, entre ellos la salud sexual con su pareja y su bienestar social. Se han descrito que solo el 44,9 % de las mujeres consultan, teniendo mayores tasas de depresión y ansiedad. El objetivo de esta investigación fue determinar la aparición de complicaciones intraoperatorias y posoperatorias con la realización de cintas transobturadora y retropúbica en el Hospital Militar Central en Bogotá durante el periodo 2015 al 2020. Se realizó un estudio observacional, descriptivo, retrospectivo de corte longitudinal, en el Hospital Militar Central en Bogotá; se incluyeron todas las pacientes con diagnósticos de incontinencia urinaria, tanto de esfuerzo, como de urgencias y/o mixtas, intervenidas con cintas medios uretrales libres de tensión por vía retropúbica o transobturadora. Las complicaciones posteriores al procedimiento quirúrgico la más prevalente fue el dolor con un 96,8 %, seguida de infección urinaria o expulsión de la banda con un 8,6 %; entre otras complicaciones menos frecuentes como hematomas, dispareunia y abscesos. La mayoría de las pacientes obtuvieron una adecuada respuesta clínica en el postoperatorio, el 77 % no requirió ningún manejo adicional. Las cintas mediouretrales, proporcionan un buen resultado con una baja incidencia de complicaciones quirúrgicas y recidiva, con mejoría de la calidad de vida de la paciente frente a su patología de incontinencia urinaria.
The International Continence Society defines urinary incontinence (UI) as the involuntary loss of urine, a potentially treatable condition with a decrease in the quality of life of women in different aspects, including sexual health with their partner and their social well-being. It has been described that only 44.9% of women consult, having higher rates of depression and anxiety. The objective of this research was to determine the occurrence of intraoperative and postoperative complications with the performance of transobturator and retropubic taping at the Central Military Hospital in Bogota during the period 2015 to 2020. An observational, descriptive, retrospective, retrospective. All patients with diagnoses of urinary incontinence, both stress, emergency, and/or mixed, operated with tension-free mid-urethral tapes by retropubic or transobturator route were included. The most prevalent complications after the surgical procedure were pain (96.8 %), followed by urinary tract infection or expulsion of the band (8.6 %), among other less frequent complications such as hematomas, dyspareunia, and abscesses. Most patients obtained an adequate clinical response in the postoperative period, 77 % did not require additional management. Mediourethral tapes provide a good result with a low incidence of surgical complications and recurrence, improving the patient's quality of life concerning her urinary incontinence pathology.
a incontinência urinária (IU) é definida pela Sociedade Internacional de Continência como a perda involuntária de urina, uma condição potencialmente tratável com uma diminuição na qualidade de vida das mulheres em diferentes aspectos, incluindo a saúde sexual com seu parceiro e seu bem-estar social. Foi relatado que apenas 44,9% das mulheres consultam, apresentando taxas mais altas de depressão e ansiedade. O objetivo desta pesquisa foi determinar a ocorrência de complicações intraoperatórias e pós-operatórias com fita transobturatória e retropúbica no Hospital Militar Central de Bogotá, Colômbia, durante o período de 2015 a 2020. Foi realizado um estudo observacional, descritivo, retrospectivo de corte longitudinal no Hospital Militar Central de Bogotá, incluindo todos os pacientes diagnosticados com incontinência urinária, tanto de esforço, de emergência e/ou mista, operados com slings mediouretrais sem tensão via retropúbica ou transobturatória. As complicações mais prevalentes após o procedimento cirúrgico foram dor (96,8%), seguida de infecção do trato urinário ou expulsão da faixa (8,6%), entre outras complicações menos frequentes, como hematomas, dispareunia e abscessos. A maioria dos pacientes teve uma resposta clínica adequada no pós-operatório e 77% não precisaram de nenhum tratamento adicional. Os slings mediouretrais proporcionam um bom resultado com baixa incidência de complicações cirúrgicas e recorrência, com melhora na qualidade de vida da paciente com relação à sua patologia de incontinência urinária.
Assuntos
Humanos , Uretra , Slings SuburetraisRESUMO
PROPÓSITO: Comparar la eficacia y complicaciones de la vía retropúbica (TVT o RP) y la vía transobturadora (TVT-O) en el tratamiento quirúrgico de la incontinencia de orina de esfuerzo (IOE). MÉTODOS: Estudio retrospectivo de pacientes con diagnóstico de IOE operadas entre Julio 2004 y Julio 2014 en el Hospital Clínico de la Universidad de Chile. Se evaluaron los datos demográficos, antecedentes médicos, síntomas y examen físico tanto preoperatorio como post operatorio y seguimiento post quirúrgico. RESULTADOS: De un total de 715, se analizaron los datos de 383 pacientes operada durante la fecha. 59,7% (n= 229) fueron sometidas a TVT-O y 40,3% (n=154) a TVT. Un 4,8% (n=11) de las pacientes en que se realizó cinta transobturadora tenían antecedente de cirugía previa de incontinencia versus un 14,29% (n=22) de las pacientes en que se realizó cinta retropúbica (P 0,006). Los datos post operatorios fueron ajustados según el dato anterior. En el seguimiento post operatorio se presentaron diferencias significativas en la disfunción del vaciamiento vesical [OR 0,28, (95%IC 0,10-0,74), p = 0,011]; y en el dolor inguinal post operatorio [OR 0,19 (95%IC 0,06-0,56), p = 0,003); siendo ambos más frecuentes en el grupo transobturador. No hubo diferencias significativas en el éxito subjetivo de la resolución de la IOE así como en otro tipo de complicaciones postoperatorias. CONCLUSIONES: Si bien ambas técnicas presentan tasas similares de éxito subjetivo en la resolución de la IOE, en nuestra experiencia, la vía transobturadora presenta mayor riesgo de disfunción del vaciamiento vesical y dolor inguinal postoperatorio.
PURPOSE: To compare the efficacy and complications of the retropubic sling (TVT or RP) and the transobturator sling (TVT-O or TOT) for the surgical treatment of stress urinary incontinence (SUI). METHODS: Retrospective study including patients diagnosed with SUI who had surgery between July 2004 and July 2014 at the Clinical Hospital of the University of Chile. Demographics, medical history, symptoms and physical examination (preoperative, postoperative and post-surgical follow-up) were evaluated. RESULTS: From a total of 715 operated during this period, the data from 383 patients was analyzed. 59.7% (n = 229) were submitted to TVT-O and 40.3% (n = 154) to TVT. 4.8% (n = 11) of patients in the transobturator sling group had previously had an incontinence surgery versus 14.29% (n = 22) of patients that had a retropubic sling (P 0.006). The postoperative data was adjusted according to this data. At the postoperative follow-up there were significant differences in bladder emptying dysfunction [OR 0.28 (95% CI 0.10 to 0.74), p = 0.011]; and postoperative groin pain [OR 0.19 (95% CI 0.06 to 0.56), p = 0.003); both being more frequent in the transobturator group. There were no significant differences in subjective success of the resolution of the SUI as well as other postoperative complications. CONCLUSIONS: Although both techniques have similar rates of subjective success in solving the SUI, in our experience, the transobturator approach has increased risk of bladder emptying dysfunction and postoperative groin pain.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Urológicos/métodos , Incontinência Urinária por Estresse/cirurgia , Slings Suburetrais , Complicações Pós-Operatórias , Chile , Estudos Retrospectivos , SeguimentosRESUMO
Objetivos: Evaluar nuestros resultados en la corrección de la incontinencia de orina de esfuerzo (IOE) con una técnica de cinta suburetral transobturatriz modificada (TOTm) con malla desnuda de polipropileno y anestesia local, midiendo efectividad, calidad de vida y grado de satisfacción por 3 años de seguimiento. Método: Evaluación prospectiva de 56 pacientes operadas entre los años 2003 y 2005, con IOE moderada o severa, según diagnóstico por clínica y cistometría simple. Se logró realizar un seguimiento del 87 por ciento de las pacientes, por 37,9 meses (19-51 meses). Se realizó control con examen físico y se aplicó una encuesta de satisfacción en visita domiciliaria por un grupo independiente de encuestadores. Resultados: Un 88 por ciento de las pacientes se encuentra sin IOE en el examen físico. A la encuesta de satisfacción, las pacientes manifestaron sentirse mejor o mucho mejor en frecuencia miccional diurna (79 por ciento), disfunción del vaciamiento vesical (69 por ciento), dolor pelviano (58 por ciento), urgeincontinencia (84 por ciento) y función sexual (53 por ciento). Un 90 por ciento manifiesta sentirse mejor o mucho mejor de la IOE que antes de la operación. La urgencia o urgeincontinencia de novo apareció en un 6 por ciento. Conclusiones: La técnica TOTm utilizada por nuestro grupo tiene resultados comparables con las técnicas TOT originales, con mejoría significativa en la calidad de vida de las pacientes.
Objective: To review our results in the correction of stress urinary incontinence (SUI) with a modified TOT technique using polypropylene mesh and local anesthesia, measuring effectiveness, quality of life and degree of satisfaction during 3 years of follow-up. Method: Prospective evaluation of 56 patients operated between 2003 and 2005, with modérate or severe SUI, or mixed urinary incontinence with effort predominance, according to clinical diagnosis and simple cystometry. A follow-up of 87 percent of the patients over a period of 37.9 months (19-51 months) was achieved. A physical examination was realized and a survey of satisfaction was applied by a team of independent interviewers on home visits. Results: On physical examination, 88 percent of patients are without SUI. In the survey of satisfaction, the patients manifested feeling better or much better in terms of daytime voiding frequency (79 percent), voiding dysfunction (69 percent), groin pain (58 percent), urge incontinence (84 percent) and sexual function (53 percent); 90 percent manifested feeling better or much better about their SUI than before the operation. De novo urgency or urge incontinence appeared in 6 percent. Conclusions: The modified TOT technique used by our group obtains results that are comparable to those of the original TOT techniques, with a significant improvement in the quality of life of patients.